Prevalence and time trends of symptoms of allergic rhinitis and rhinoconjunctivitis in Spanish children: Global Asthma Network (GAN) study

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Alberto Bercedo-Sanz
Antonela Martínez-Torres
Angel López-Silvarrey Varela
Francisco Javier Pellegrini Belinchón
Ines Aguinaga-Ontoso
Carlos González Díaz
Luis García-Marcos
Grupo GAN Spain


Rhinitis, Rhinoconjunctivitis, Adolescent, Schoolchild, Prevalence, Cross-sectional Studies, Global Asthma Network


Introduction: The time trends of the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy previously described in the ISAAC (International Study of Asthma and Allergies in Childhood) in 2002 are unknown; or if the geographical or age differences in Spain persist.

Objective: To describe the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy in different Spanish geographical areas and compare them with those of the ISAAC.

Methods: Cross-sectional study of the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy, carried out in 2016-2019 on 19943 adolescents aged 13-14 years and 17215 schoolchildren aged 6-7 years from six Spanish areas (Cartagena, Bilbao, Cantabria, La Coruña, Pamplona, and Salamanca), through a questionnaire based on the Global Asthma Network (GAN) protocol.

Results: The prevalences of recent rhinitis and rhinoconjunctivitis (last 12 months), and nasal allergy/hay fever were 35.1%, 17.6%, and 14.6% in the adolescents and 20%, 8.5%, and 8.9% in the schoolchildren, respectively, with rhinoconjunctivitis in adolescents varying from 20.9% in Bilbao to 13.4% in Cartagena; and in schoolchildren, from 9.8% in La Coruña to 6.4% in Pamplona. These prevalences of rhinoconjunctivitis and nasal allergy in adolescents were higher than those described in the ISAAC (16.3% and 13%) and similar in schoolchildren to the ISAAC (9% and 9.4%).

Conclusions: There has been a stabilisation of rhinitis, rhinoconjunctivitis and nasal allergy in schoolchildren that slows the previous upward trend of ISAAC; and a slight non-significant increase in rhinoconjunctivitis and nasal allergy in adolescents. The variability found in adolescents would require local research to be better understood.

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1. Asher MI, Montefort S, Björkstén B, Lai CKW, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross--sectional surveys. Lancet. 2006;368:733–743. 10.1016/S0140-6736(06)69283-0
2. Strachan D, Sibbald B, Weiland S, Aït-Khaled N, Anabwani G, Anderson HR, et al. Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of asthma and Allergies in Childhood (ISAAC). Pediatr Allergy Immunol. 1997;8:161–176. 10.1111/j.1399-3038.1997.tb00156.x
3. Odhiambo JA, Williams HC, Clayton T, Robertson CF, Asher MI, and the ISAAC Phase Three Study Group. Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol. 2009;124:1251–1258. 10.1016/j.jaci.2009.10.009
4. Mallol J, Crane J, von Mutius E, Odhiambo J, Keil U, Stewart A, et al. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: a global synthesis. Allergol Immunopathol (Madr). 2013;41:73–85. 10.1016/j.aller.2012.03.001
5. García-Marcos L, Batlles-Garrido J, Blanco-Quiros A, García Hernández G, Guillén-Grima F, González Díaz C, et al. Influence of two different geo-climatic zones on the prevalence and time trends of asthma symptoms among Spanish adolescents and schoolchildren. Int J Biometeorol. 2009;53:53–60. 10.1007/s00484-008-0190-3
6. Arnedo-Pena A, García-Marcos L, Bercedo-Sanz A, Aguinaga-Ontoso I, González-Díaz C, García-Merino A, et al. Prevalence of asthma symptoms in schoolchildren, and climate in west European countries: an ecologic study. Int J Biometeorol. 2013;57:775–784. 10.1007/s00484-012-0606-y
7. Arnedo-Pena A, García-Marcos L, Carvajal Urueña I, Busquets Monge R, Morales Suarez-Varela M, Miner Canflanca I, et al. [Air pollution and recent symptoms of asthma, allergic rhinitis, and atopic eczema in schoolchildren aged between 6 and 7 years]. Arch Bronconeumol. 2009;45:224–229. 10.1016/j.arbres.2008.10.004
8. García-Marcos L, Miner Canflanca I, Batllés Garrido JB, López-Silvarrey Varela A, García-Hernádez G, Guillén Grima F, et al. Relationship of asthma and rhinoconjunctivitis with obesity, exercise and Mediterranean diet in Spanish schoolchildren. Thorax. 2007;62:503–508. 10.1136/thx.2006.060020
9. Nagel G, Weinmayr G, Kleiner A, García-Marcos L, Strachan DP. Effect of diet on asthma and allergic sensitisation in the International Study on Allergies and Asthma in Childhood (ISAAC) Phase Two. Thorax. 2010;65:516–522. 10.1136/thx.2009.128256
10. Garcia-Marcos L, Castro-Rodriguez JA, Weinmayr G, Panagiotakos DB, Priftis KN, Nagel G. Influence of Mediterranean diet on asthma in children: a systematic review and meta-analysis. Pediatr Allergy Immunol. 2013;24:330–338. 10.1111/pai.12071
11. Mitchell EA, Beasley R, Bjorksten B, Crane J, García-Marcos L, Keil U, et al. The association between BMI, vigorous physical activity and television viewing and the risk of symptoms of asthma, rhinoconjunctivitis and eczema in children and adolescents: ISAAC Phase Three. Clin Exp Allergy. 2013;43: 73–84. 10.1111/cea.12024
12. The Global Asthma Network manual for global surveillance: prevalence, severity, management and risk factors. Available from: [cited 19 June 2022].
13. Ellwood P, Asher MI, Billo NE, Bissell K, Chiang CY, Ellwood EM, et al. The Global Asthma Network rationale and methods for Phase I global surveillance: prevalence, severity, management and risk factors. Eur Respir J. 2017;49:1601–1605. 10.1183/13993003.01605-2016
14. Ellwood P, Ellwood E, Rutter C, Perez-Fernandez V, Morales E, García-Marcos L, et al. Global Asthma Network Phase I surveillance: geographical coverage and response rates. J Clin Med. 2020;9:3688. 10.3390/jcm9113688
15. Asher MI, Rutter CE, Bissell K, Chiang CY, El Sony A, Ellwood E, et al. Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross--sectional study. Lancet. 2021;398:1569–1580. 10.1016/S0140-6736(21)01450-1
16. Bercedo Sanz A, Martínez-Torres A, González Díaz C, López-Silvarrey Varela A, Pellegrini Belinchón FJ, Aguinaga-Ontoso I, et al. Prevalencia y evolución temporal de síntomas de asma en España. Estudio Global Asthma Network (GAN). An Pediatr (Bar). 2022;97(3):161–171. 10.1016/j.anpedi.2021.10.007
17. García-Marcos L, Blanco Quirós A, García Hernández G, Guillén-Grima F, González Díaz C, Carvajal Urueña I, et al. Stabilization of asthma prevalence among adolescents and increase among schoolchildren (ISAAC phases I and III) in Spain. Allergy. 2004;59:1301–1307. 10.1111/j.1398-9995.2004.00562.x
18. Carvajal-Urueña I, García-Marcos L, Busquets-Monge R, Morales Suarez-Varela M, García de Andoni N, Batles-Garrido J, et al. Geographic variation in the prevalence of symptoms in Spanish children and adolescents. International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3, Spain. Arch Bronconeumol. 2005;41:659–666. 10.1016/S0300-2896(05)70721-3
19. Strachan DP, Rutter CE, Asher MI, Bissell K, Chiang CY, El Sony A, et al. Worldwide time trends in prevalence of symptoms of rhinoconjunctivitis in children: Global Asthma Network Phase I. Pediatr Allergy Immunol. 2022;33:e13656.
20. Arnedo-Pena A, García-Marcos L, Blanco-Quiros A, Martínez Gimeno A, Aguinaga Ontoso I, González Díaz C, et al. Evolución temporal de la prevalencia de síntomas de rinitis alérgica en escolares de 13.14 años de 8 áreas españolas entre 1993–1994 y 2001–2002 según el Estudio internacional sobre asma y Alergia en lainfancia (ISAAC). Med Clin (Barc). 2004;123(13):490–495. 10.1016/S0025-7753(04)74569-8
21. Arnedo-Pena A, García-Marcos L, García-Hernández G, Aguinaga Ontoso I, González Díaz C, Morales Suarez-Varela M, et al. Tendencia temporal y variaciones geográficas de la prevalencia de síntomas de rinitis alérgica en escolares de 6–7 años de ocho áreas españolas, según el ISAAC. An Pediatr (Barc). 2005;62(3):229–236. 10.1157/13071837
22. Ellwood P, Williams H, Ait-Khaled N, Bjorksten B, Robertson C, ISAAC Phase III Study Group. Translation of questions: the International Study of Asthma and Allergies in Childhood (ISAAC) experience. Int J Tuberc Lung Dis. 2009;13:1174–1182.
23. Instituto Murciano de Investigación Biosanitaria (IMIB). Investigación en Pediatría. Global Asthma Network. Available from: [cited 19 June 2022].
24. ISAAC Phase III Study Group Español. Prevalencia de síntomas sugestivos de rinitis alérgica y de dermatitis atópica en adolescentes (Estudio ISAAC España). An Esp Pediatr. 1999;51:369–376.
25. García-Marcos L, Innes Asher M, Pearce N, Ellwood E, Bissell K, Chiang CY, et al. The burden of asthma, hay fever and eczema in children in 25 countries: GAN Phase I study. Eur Respir J. 2022;60(3):2102866. 10.1183/13993003.02866-2021
26. García-Almaraz R, Reyes-Noriega N, Del-Río-Navarro BE, Berber A, Navarrete-Rodríguez EM, Ellwood P, et al. Prevalence and risk factors associated with allergic rhinitis in Mexican school children: Global Asthma Network Phase I. World Allergy Organ J. 2021;14(1):100492. 10.1016/j.waojou.2020.100492
27. Reijula J, Latvala J, Mäkelä M, Siitonen S, Saario M, Haahtela T. Long-term trends of asthma, allergic rhinitis and atopic eczema in young Finnish men: a retrospective analysis, 1926–2017. Eur Respir J. 2020;56:1902144. 10.1183/13993003.02144-2019
28. Brozek G, Lawson J, Szumilas D, Zejda J. Increasing prevalence of asthma, respiratory symptoms, and allergic diseases: four repeated surveys from 1993–2014. Respirar Med. 2015;109(8):982–990. 10.1016/j.rmed.2015.05.010
29. Centers for Disease Control and Prevention. Most recent national asthma data. Available from: [cited 19 June 2022].
30. Doğruel D, Bingöl G, Altıntaş DU, Seydaoğlu G, Erkan A, Yılmaz M. The trend of change of allergic diseases over the years: three repeated surveys from 1994 to 2014. Int Arch Allergy Immunol. 2017;173(3):178–182. 10.1159/000477726
31. Fuseini H, Newcomb DC. Mechanisms driving gender differences in asthma. Curr Allergy Asthma Rep. 2017;17(3):19. 10.1007/s11882-017-0686-1
32. Wei JX, Ggerlich J, Genuneit J, Nowak D, Vogelberg C, von Mutius E, et al. Hormonal factors and incident asthma and allergic rhinitis during puberty in girls. Ann Allergy Asthma Immunol. 2015;115:21–27.e22. 10.1016/j.anai.2015.04.019